The Ultimate Self Rehab Guide for Low Back Pain
You will put back pain to rest with this self-treatment guide. No doctors, therapists, or pain specialists are required, only a simple plan to help you feel better and move better.
You will learn about your back, the four pillars to reduce low back pain, and then create a two week prescription plan based on your needs.
It's your opportunity to kick the nuisance of pain flare-ups that stop you during sports and other activities. Of course, high-stress things like weightlifting and golf are common culprits, but it can also be simple life activities like playing with your kids, working in the yard, or even sitting at a desk that can set you back.
Even if it's not pain, but stiffness and those feelings of getting old, give self-rehab a shot to get back to your youth. Within a few weeks, your effort and commitment to this guide's training will decrease your pain and lead you to permanent improvement.
Then you'll be ready to start the second part of the program that will help your fight pain for the long run while also improving your strength and mobility.
Table of Contents
Is Self Rehab Right for You?
As the name implies, you're the leader and patient for self-rehab.
We will give you the directions, but ultimately it's up to you to make it happen. For that reason, some people have better success with the accountability of a clinician to help guide them.
But, if you can stick to a plan and are motivated to save yourself from the time and expense of dealing with traditional therapy, then you meet the most important criteria for success with self-rehab.
Although, if your pain is so debilitating that you have trouble getting out of bed, we encourage more direct care to handle your symptoms. Then with better pain management, this self-rehab guide will lead to your long-term success.
Use these guidelines before starting rehab.
Red Light: Needs medical management.
Yellow Light: Use this guide, but alongside other medical directions.
Green Light: Self-care management
What to Expect
The Self Rehab Guide will first cover some misconceptions and beliefs about the cause of low back pain to empower you to take control of the problem.
But before starting your rehab journey, you will go through our Red Flag Screen to assess yourself for potentially more complex problems.
Once you clear the red flags, you'll be ready to start the first of two phases of the low back pain self rehab program.
Phase I - 2 Weeks
You'll start with a two-week plan to get you ahead of the pain.
This provides a good start to get you out of pain, but it's also where many people fail on their rehab journey. They complete two weeks of work and put the lessons away in the closet until the next flair-up.
The ultimate goal is to lead you to forever improvement without back pain ever setting in again. So once your pain has subsided, you're in a perfect position to begin Phase II of the plan.
Phase II - 30 Days
Phase II includes strengthening and stretching to improve your movement so that you can build some resiliency to continue your life pain-free, but as we all know, strength also lends itself to performance improvements.
Expect in this phase that your pain will continue to subside and you will start moving better as well.
Phase II will use the CS Hip & Core Band and follow the 30-Day Low Back Fix for a step-by-step plan to make you stronger.
Go here to learn more about the Low Back Fix and the Crossover Symmetry Hip & Core System. If you purchase now, you'll have it ready for when the time is right to move onward.
Ultimately, this program is for active people who can't get ahead of their pain, are committed to making a change, and are ready to do it independently.
Good luck on your journey! And remember, the prognosis for most low back pain is good, but it requires a consistent attack plan to be impactful.
The team here at Crossover Symmetry is available to support you. Please reach out to us at email@example.com if we can answer any questions along the way.
Chapter 1: Why Does Your Back Hurt?
Low Back Pain Myths
Back pain is not as sinister as it was a decade ago.
Many of the previously held beliefs that led many to surgery or spending money on scans, medication, and other medical procedures are not usually necessary.
Or, at the very least, not without a bout of conservative care first.
In 2020, Peter O Sullivan, an internationally recognized expert on the complex science of pain, released an article summarizing the latest research on back pain.
The key conclusions will likely surprise you:
- Persistent low back pain can be scary but rarely dangerous
- Getting older is not a cause of low back pain
- Constant back pain is rarely associated with serious tissue damage
- Scans rarely show the cause of back pain
- Pain with exercise and movement doesn't mean you are doing harm
- Back pain is NOT caused by poor posture
- Back pain has NOT been shown to be caused by a weak core
- Backs do not wear out with everyday loading and bending
- Pain flare-ups don't mean you are damaging yourself
- Injection, surgery, and strong drugs aren't usually a cure
Keep these things in mind as you move forward with your self-guided rehab.
Anatomy & Understanding What Hurts
We won't go too far into the spine's anatomy; however, understanding the general framework will help clarify a few misconceptions about the back.
Spine Structure: The Vertebrae & Disks
Our spine has 33 vertebrae (or bones), with a disc between each vertebra to absorb shock and help disperse the load between segments.
Many clinicians describe the disk as a jelly donut between the two vertebrae. However, it is far more durable than a fluffy breakfast pastry. The best analogy is from physiotherapist Adam Meakins, who describes the disk as a truck tire filled with chewing gum.
It's not as appealing, but a much more accurate representation of the disk's durability and resilience to damage.
The thought of an injured disk tends to strike fear due to its association with ominous terms like "slipped" or "herniated," which leads people to believe a surgical repair is their only hope.
The good news is that disc protrusions are very treatable and will heal over time despite various issues. In fact, a good percentage of the population over 40 will find some disc abnormality on their MRI yet have zero symptoms.
Therefore, an image or MRI of your back doesn't reveal as much as people tend to believe and lead to unnecessary medical procedures. It may even prolong the pain. Several studies show your perspective is a massive factor behind pain because an underlying belief that you're broken will cause your brain to increase pain and limit movement to protect you.
Therefore, it's true that a damaged, swollen, or inflamed disk may cause pain, but remind yourself that just like other injuries, your body is capable of repair, and a progressive and consistent rehab plan is an effective fix.
Reframing the rhetoric is vital to the success of any rehab program.
You may have seen images similar to the one below that show the nerves coming from different spine segments to monitor and control specific areas.
(Image from: © Kenhub - Illustrator: Irina Münstermann https://www.kenhub.com/)
Knowing this anatomy is far from necessary for your recovery, but it's good to appreciate that other discomfort around your body might occur due to an interference of the nerve for that part of the body.
Essentially, sometimes your back problem might not feel like pain in your back. For example, you may feel pain in your glute or hamstring because of the specific nerve involved.
There is nothing to worry about specifically, but it explains how random symptoms may be back-related.
It also brings us to the complexity of pain. And what you're feeling is a perception of the brain based on tons of information it's receiving from the body. The pressure on a nerve root or inflammation in a region might be directly related, but it can also be emotions or stress that adds to that input.
The ultimate goal is to change the brain's perception of the danger signals it's receiving. This is done with time for healing and progressing through pain-free movement.
The back muscles can get complex, but the big picture is simple by dividing them into the big movers and the smaller stabilizers.
Most people are familiar with the "big movers" and blame those for their low back pain. Examples include your abs and the big back muscles we tend to massage, stretch, and foam roll in an attempt to manage pain.
However, the deep stabilizers of the back are usually less appreciated. Those muscles include the deep and unseen abdominal muscles and the small muscles that connect one spine segment to the next. These less visible muscles are essential in controlling movement and creating "stability" of the spine.
The main point is that you may work your abs often and be rather proud of your plank time, but other less sexy stabilizers are equally as important.
Take Charge of Your Low Back Pain
The first goal of this program is to get you out of pain by using small but frequent doses from the pillars of back pain rehab that you identify as most important for your problem.
If you're serious about getting rid of low back pain, then make it your duty to complete the first phase for at least two weeks, and you should see significant improvement in your symptoms.
Once you've completed Phase I, you'll be ready to move to Phase II, where you will build your movement ability to help your back stay strong.
Phase II starts your forever journey to staying more active and committing to habits that will keep you loose and limber. But first, jump into the next chapter for The Red Flag Screen to determine if you're ready to take on a self-rehab program.
Chapter 2: Red Flags
You can fix most back pain on your own without the time and expense of medical care. However, some issues need to be assessed by a healthcare professional to get more advanced treatment.
The following will assess for more critical things that we call Red Flags.
Checking one of the following boxes does not mean this rehab plan won't work for you, but it does indicate that you should get an assessment to ensure you're on the right track.
Review the following red flags to see if you're ready to move forward.
Pain w/ Traumatic Onset
Pain with a traumatic onset (e.g., a fall, motor vehicle accident, or hard collision playing sports) should first seek medical attention. If pain is present, but its onset was progressive or from overuse (e.g., you spent a weekend shoveling rocks for a garden project,) this is not a red flag if all other screens are negative.
Atrophy or Asymmetry
Significant shrinking or asymmetry of the glute, thigh, or calf muscles can indicate progressive long-standing nerve involvement that needs further evaluation.
Obvious Dysfunctional Movement
Aberrant movement during or returning from a forward bend or moving between sitting and standing is a red flag—examples include walking the hands on the thighs and noticeable trunk shifts as you stand up.
Radiating Weakness, Numbness, or Tingling Below the Butt
Persistent sensations going down the leg such as burning, numbness, or tingling, or weakness that prevents walking on the heels or toes needs further evaluation by a medical professional.
Changes in Bowel or Bladder Function
Unable to Find a Position of Comfort
Significant pain at all times, unrelieved with rest or inactivity.
Unexpected Weight Loss or Gain
Rapid changes in body weight without deviations in lifestyle activities, especially with a history of cancer anywhere in the body.
There should be improvements in pain and mobility as you go through rehab. Of course, not every day will be remarkably better than the day before, but your typical pain level should trend towards improvement over time.
Even slight improvements mean you are on the right track and should continue the program. However, if you've attempted self-rehab for 2-weeks with no improvement, then this is a red flag and should prompt a visit to a medical professional.
Chapter 3: The 4 Pillars of Back Pain Rehab
First, let's address one of the common complaints that people in pain have with their rehab: there is hardly ever consistency in treating low back pain.
You may see ten different back pain specialists and get ten unique plans—and I know if that's your situation, it feels frustrating! If ten doctors diagnosed your ankle sprain, you would likely get similar answers and solutions.
So, what gives with low back pain?
The biggest reason is that different providers see different problems for back pain more than any other pain. Some see tissue damage or inflammation, some see symptoms, and some see "underlying causes" that range from too much sitting to deep emotional scars from your past.
Also, different specialists will use varying words to describe a similar diagnosis. Depending on the source, your physician, physical therapist, chiropractor, osteopath, or massage therapist may all have similar ideas about what's causing your pain. Still, their words and emphasis may sound different.
But fear not! This guide (and how most modern-day providers tackle low-back pain) will focus on the treatment rather than a diagnosis. That means instead of focusing on "the image" that may highlight specific problems (i.e., your MRI or strength assessment), you will focus on things that provide relief and time to allow for healing.
Relieving stiffness and discomfort in the lower back has four primary treatment pillars.
4 Pillars for Treating Low Back Pain
Treatments for low back pain fall into four different categories:
- Directional Preference
As you start reading, understand that most people don't fall perfectly into just one category but a mix of each. If everyone fell perfectly into one treatment bucket, we wouldn't have as many challenges managing low back pain.
So look for trends, and understand you will likely need a few of these things.
Ultimately, the following chapters should help identify the priorities for your rehab and provide you with the foundation to craft a treatment plan in the next chapter.
Some people find that moving one way aggravates their symptoms, whereas bending the spine in another way provides relief.
Essentially, your spine prefers one direction over the other.
Once you've confirmed your directional preference, you can use that knowledge to aid your relief.
You're probably familiar with the Mckenzie Method if you've researched back pain exercises. It's a standard treatment for directional-based back pain that's worked for many, but the key is consistency and building through the progression.
What's Your Preference?
We broadly categorize directional back pain as either a flexion or extension preference. You can determine this by doing an at-home assessment.
Your back has a flexion preference if you notice that you feel better by rounding the low back. Relief by sitting, pulling your knees to your chest, or doing a child's pose, indicates that you have a flexion preference. Additionally, if you find that extending the spine, such as a cobra position is painful, then you likely have flexion preference.
Your back has an extension preference if arching your back provides relief. If a cobra pose feels good or walking helps your pain then you likely prefer an extension pattern. Or, if prolonged sitting or transitioning from a sitting to standing irritates your back, then you likely have an extension preference.
To determine your directional preference, try moving in those directions to see what bothers you and what provides relief.
- Don't force your spine to move in any direction you feel apprehensive.
- Stop the movement if symptoms go past your butt and into the leg.
- Flexion Preference = Bend forward and hold for 5-10 seconds - Repeat this motion 10x and check in.
- Extension Preference = Bend backward and hold for 5-10 seconds - Repeat this motion 10x and check in.
|Test for Flexion Preference||
Test for Extension Preference
Stability is a broad term that describes a lack of strength to support your body.
There are assessments to determine if and what needs better stability, but just assume you need stability work.
It will help you connect with your deep stabilizers better and overall movement is part of the healing process.
Another consideration is that some people are naturally exceptionally limber and need additional work on controlling their joints.
The Beighton Scale is the most common way to identify those with extra laxity.
Extra laxity isn't inherently a diagnosis but it does indicate a particular need for strength and stability. It can also be a sign of other rare conditions that would require additional medical testing.
Mobilization is a broad term that means you need to help your back to get it moving again. Mobilization strategies include stretching, massage, adjustments, and manipulations.
The reason for mobilization is that your body does an excellent job of protecting itself from danger.
When it perceives something as a threat, its first response is pain, to motivate you to stop doing something damaging. In addition to a painful danger signal, muscles lock down or "spasm" to restrict movement.
It's brilliant, and you should be thankful that this occurs, but sometimes, the body can be overly cautious and needs some input to understand what's truly dangerous.
It's a pretty simple criterion for who needs mobilization for their low back pain:
- If your symptoms have lasted less than 16 days and your pain doesn't radiate down your leg, you fall nicely into the mobility category.
Should you get a spine adjustment?
If you meet the criteria for mobilization (your pain is a relatively new problem,) an adjustment or spine manipulation will likely help your symptoms. Many specialists do this, but you can get similar results with some self-mobilizations.
Either way, here is a helpful tip that can save you a lot of money:
An adjustment or manipulation you receive is not putting anything back into place. Instead, it's getting things moving again to reset the nervous system and reduce the restriction of tight spine sections. Also, while satisfying, the audible "crack" doesn't provide more than some stretching.
If you enjoy the "adjustments" a chiropractor or physical therapist provides, that's great! It's checking a box to help get you out of pain, but the clinician should advise you on other steps to help your issue.
And while mobilization done by a professional can provide a very specific stretch to an area of the spine, the general mobilizations covered in this guide can simulate similar techniques and reach the same outcome.
Please consider this if you have been stuck in a cycle of adjustments with only short-term relief. Simply following the Treatment Plan in Chapter 4 can work just as well.
When all else fails, take some pressure off! Traction is a catch-all category if you don't fit well into the directional preference or mobility categories.
The idea with traction is to give the segments of your spine a bit of breathing room. It gives you a window of opportunity to loosen up the back enough to move you into the next phase of the program.
Although, traction might provoke your pain if your back is exceptionally pissed off. So slow your roll before you flip yourself upside down.
Chapter 4: The Treatment Plan
The First Two Weeks
The initial program for back pain is to find some relief. You will turn up the dial on the pillars of back pain rehab to do this.
Add the directed rehab to your prescription for each rehab pillar you've checked off, and aim to complete your rehab program 5x per day.
Step 1: Stop the Thing That's Painful!
Think of the first few weeks as a reset button. We need to give your back a short vacation from provocative movements. Heavy workouts and other strenuous activities will keep poking at your pain, so take them out of your life for this first part of the plan.
Although, this rest doesn't mean you should do nothing. Finding ways to stay moving will help you progress and can satisfy your exercise itch to keep you from getting antsy.
Use the template for your exercise program.
Start with "green light" exercises for the program's first phase.
You may progress to the "yellow light" exercises after the first week, but test them first for tolerance as part of a light warm-up movement. If you don't notice any negative effects, add them to your program at lighter weights and volume than usual.
The red light exercises should be the last ones you add and will only occur later in the program's second phase.
- Bodyweight Exercises (that don't require bending the spine).
- Squats, lunges, step-ups, planks, etc.
- Upper body exercises for the chest, back, and arms.
- KB swings
- Kipping Pull-ups
- Wall Balls/Thrusters
- Deadlifts & Olympic Lifts
Step 2: Get Moving
It's a common thought to rest a painful area which is accompanied by fear that the pain will only worsen if you keep pushing things.
Taking time off from heavy or explosive movements is certainly good, but ultimately a painful back needs to keep moving.
Add more walking to your day and avoid getting stuck in a single position for too long.
Step 3: Treatment Pillars
Emphasize your treatment pillars every day for at least two weeks of Phase I.
Start by feeding into the directional preference that you've found to prefer.
- Sitting improves your pain.
- Walking increases your pain.
- Repeated forward bends decrease your pain.
- A child's pose stretch reduces your pain.
- Walking improves your pain.
- Sitting makes it worse.
- Putting pants or shoes on is painful.
- Repeated backward bends decrease your pain.
Extension Preference - Do 5 Sets of 10 Cobra Stretches Every Day
Flexion Preference- Do 5 Sets of 10 Knees to Chest or Child's Pose Every Day
This is more than one-and-done!
Instead, do the stretch of comfort multiple times per day. Start with five sets of 10 repetitions of the movement that decreases your pain, and then work up as your schedule allows.
Dead bugs and bird dogs aren't the end-all for treating back pain, but they are a beneficial place to start. These exercises are the nuts and bolts to learning how to control the spine and should be the initial focus.
Start by performing five sets of 10 reps of the following exercises throughout the day for two weeks.
These movements help you connect with your deep stabilizers to get them turned on. You can drop down and do a set of 10 in your work clothes without sweat.
- Dead Bug
- Bird Dog
- Glute Bridge
Do the following spinal twist exercise daily:
You can jump into this if you only have minor irritation and don't have a directional preference. But stop if you notice that it's causing more irritation, then wait a week to implement traction.
Or, if you've gone through the first week and have yet to improve, try implementing some traction.
Options for Traction
Premium Option - Inversion Table
Partner Assisted - Home Traction Hacks for the Lumbar Spine
Band Beginner - Low Back Traction with Band
Band Advanced - Hanging Bands for Hip Traction/Spinal Decompression
Chapter 5: The Second Phase
Ask anyone, and they will likely mention something about strength when asked about back pain. But, at the same time, it remains extremely underutilized.
If you visited a chiropractor or physical therapist about your back pain, they likely showed you some basic exercises as they mentioned you need better stability.
That is an appropriate start, but true "stability" will require much more.
The body needs to feel safe to take on the movements your life demands, which is likely more intense than lying on your back and moving slowly.
Therefore, these simple therapy exercises will give you a good start, but that foundation is too small to sustain things like lifting weights, chasing kids, swinging golf clubs, and doing other physical tasks.
So while the initial phase likely got you out of pain, it will not be enough to keep you from tweaking your back again. The next step is to master and strengthen foundational movements that occur in your life.
You don't need to set any weightlifting records, but becoming proficient at lifting, bending, and rotating will prepare your back for an active life.
The next step is to develop movement patterns to reinforce those things that will keep you from spending all your time and money managing your low back.
You can take the next step with the CS Hip & Core System and the included 30-Day Back Fix. This program will help strengthen the key muscle groups and reinforce movement patterns that will help reduce your risk of injuring your back.
However, like the initial phase of this plan, the key to success is consistency. Unfortunately, this is usually a huge missing link for people following a back injury. They implement stretches and adjustments to get rid of the pain but then fail to do things to keep it away.
The 30-Day Low Back Fix will help you take that next step to keep your pain from returning and your performance moving upward.